Rivertown Dental Excellence

Primary specialty

DentistTaxonomy code 122300000X

License

2901019772 Issued in MI

Legal business name

RIVERTOWN DENTAL EXCELLENCE

Practice address

4565 Wilson Ave SW
Suite 2a
Grandville, MI 49418-2371

Phone

(616) 538-0770

Fax

(616) 538-0359

NPI assigned

Feb 1, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jared M Van Ittersum, D.D.S.

Title

Owner

Phone

(616) 538-0770

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1558633909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4565 WILSON AVE SW",
            "address_2": "SUITE 2A",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182371",
            "telephone_number": "616-538-0770",
            "fax_number": "616-538-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4565 WILSON AVE SW",
            "address_2": "SUITE 2A",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182371",
            "telephone_number": "616-538-0770",
            "fax_number": "616-538-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERTOWN DENTAL EXCELLENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "VAN ITTERSUM",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-538-0770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Reyes, LLMSW
• Lauren Ashley Reynolds, H.I.S
• Diane K Richardson, NP
• Tracy Lyn Ridder, PHARMD
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• Mikaela Renee Roach
• Rebecca Marie Robins, BEHAVIOR TECHNICIAN
• William H Roedema, D.D.S., M.S.
• Ty Rollin, DDS
• Jennifer Romano

• Dentist in Grandville, MI
• Providers in Grandville, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.